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Perscription Refills

This is for Prescription refills only. You must be a patient at the Lansing office. Please allow 24-48 hours for all routine medications and up to 72 hours for controlled substances on business days (Monday - Thursday 8 a.m.-5 p.m., Friday 8 a.m. - 12 p.m.).

Patient's First Name (required):
Patient's Last Name (required):
Patient's Date of Birth (required):	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 1893 1892 1891 1890 1889
Email Address (required):
Verify Email Address (required):
Phone Number (required):
Prescribing doctor's name (required):	(select) Dr. Vikas Bajpai Dr. C.B. Dehlin Dr. Chris Farnum Dr. Barbara Fretwell Dr. Amit Ghose Dr. Omada Idachaba Dr. Michael Kowalczyk Dr. Anthony Meier Dr. Anne Missavage Dr. George Ristow Dr. Laura Schultz Dr. Mary Werkman Dr. Erik Wert Dr. Eileen Wheeler

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	Name of Medication	Strength & Dosage	Dispense
1.			30 Day Supply 90 Day Supply
2.			30 Day Supply 90 Day Supply
3.			30 Day Supply 90 Day Supply
4.			30 Day Supply 90 Day Supply
5.			30 Day Supply 90 Day Supply
6.			30 Day Supply 90 Day Supply
7.			30 Day Supply 90 Day Supply

Pharmacy Name (required):
Location:
Pharmacy Phone Number (if known):

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Please feel free to provide any additional information or comments if necessary:

You will receive an e-mail confirming your prescription request.
Please allow 48 to 72 hours to process your request.
After clicking Submit, it may take up to a minute to record your information.
Please do not click the submit button again during this time.